Prescription opioid use before and after heart transplant: Associations with posttransplant outcomes

Impacts of the prescription opioid epidemic have not yet been examined in the context of heart transplantation. We examined a novel database in which national U.S. transplant registry records were linked to a large pharmaceutical claims warehouse (2007‐2016) to characterize prescription opioid use b...

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Bibliographic Details
Published in:American journal of transplantation 2019-12, Vol.19 (12), p.3405-3414
Main Authors: Lentine, Krista L., Shah, Kevin S., Kobashigawa, Jon A., Xiao, Huiling, Zhang, Zidong, Axelrod, David A., Lam, Ngan N., Segev, Dorry L., McAdams‐DeMarco, Mara Ann, Randall, Henry, Hess, Gregory P., Yuan, Hui, Vest, Luke S., Kasiske, Bertram L., Schnitzler, Mark A.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Analgesics, Opioid - adverse effects
anesthesia/pain management
clinical research/practice
Drug Prescriptions - statistics & numerical data
Epidemiology
Female
Follow-Up Studies
health services and outcomes research
Heart Diseases - mortality
Heart Diseases - surgery
Heart transplantation
Heart Transplantation - adverse effects
Heart Transplantation - mortality
heart transplantation/cardiology
Heart transplants
Humans
Male
Middle Aged
Morphine
Narcotics
Opioid-Related Disorders - etiology
Opioid-Related Disorders - mortality
Opioids
Pain management
Postoperative Complications - etiology
Postoperative Complications - mortality
Prognosis
registries
Registries - statistics & numerical data
Retrospective Studies
risk assessment/risk stratification
Risk Factors
Scientific Registry for Transplant Recipients (SRTR)
Skin & tissue grafts
Surgical outcomes
Transplants & implants
Young Adult
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Summary:Impacts of the prescription opioid epidemic have not yet been examined in the context of heart transplantation. We examined a novel database in which national U.S. transplant registry records were linked to a large pharmaceutical claims warehouse (2007‐2016) to characterize prescription opioid use before and after heart transplant, and associations (adjusted hazard ratio, 95% LCLaHR95% UCL) with death and graft loss. Among 13 958 eligible patients, 40% filled opioids in the year before transplant. Use was more common among recipients who were female, white, or unemployed, or who underwent transplant in more recent years. Of those with the highest level of pretransplant opioid use, 71% continued opioid use posttransplant. Pretransplant use had graded associations with 1‐year posttransplant outcomes; compared with no use, the highest‐level use (>1000 mg morphine equivalents) predicted 33% increased risk of death (aHR 1.101.331.61) in the year after transplant. Risk relationships with opioid use in the first year posttransplant were stronger, with highest level use predicting 70% higher mortality (aHR 1.461.701.98) over the subsequent 4 years (from >1 to 5 years posttransplant). While associations may, in part, reflect underlying conditions or behaviors, opioid use history is relevant in assessing and providing care to transplant candidates and recipients. Examination of integrated U.S. transplant registry data and records from a nationwide pharmacy claims warehouse demonstrates that pretransplant prescription opioid use is associated with a 33% increased risk of death over the first year posttransplant, that most high‐level opioid users continue to fill at high levels in the year after transplant, and that posttransplant prescription opioid use has even stronger prognostic significance, with highest level use predicting 70% increased risk of death over the subsequent 4 years.
ISSN:1600-6135
1600-6143
DOI:10.1111/ajt.15565